PROJECT SUMMARY Substance use disorders disproportionately affect individuals seeking treatment in Emergency Departments (EDs). Nicotine addiction is a commonly reported substance use disorder in ED populations that impacts adults directly and their children through secondhand smoke exposure (SHSe). EDs are uniquely positioned to deliver preventive intervention for tobacco use disorders to at-risk adult and child populations with limited access to sources of preventive care. While EDs could expand medical care to include a focus on health promotion and disease prevention for children and their caregivers, implementation of such efforts is rare. Commonly reported barriers include time, resources, and skill in public health intervention. Thus, there is a call to train scientists capable of leading multi-disciplinary research that extends the clinical mission of EDs to include health promotion and disease prevention efforts. However, little attention has been given to quantifying the contribution child SHSe has on pediatric ED (PED) utilization and exploring how to effectively implement SHSe reduction interventions into this opportune setting. Therefore, the specific aims of this project are: 1) To determine the contribution that child SHSe has on healthcare utilization and related costs in SHS-exposed children who present to the PED compared with unexposed children; 2) To select one of two existing, evidence-based SHSe reduction interventions, and identify ways to adapt and successfully implement the intervention in the PED setting by conducting focused interviews with physicians, nurses, social workers, and healthcare administrators; and 3) To develop an implementation plan and corresponding manual of procedures for use in a future R01 SHSe reduction intervention that will be adapted for the PED setting. The successful completion of the proposed project will result in identification of the health and economic burden of child SHSe on the PED and creation of an implementation plan to reduce SHSe to be tested in a future R01 trial. Dr. Ashley L. Merianos, the candidate, is an Assistant Professor at the University of Cincinnati. The National Institutes of Health Mentored Research Scientist Development Award (K01) will provide the candidate with fundamental research and career training in mixed-methods methodology and preventive intervention to implement the proposed work. Dr. Merianos? long-term career goal is to be a health services researcher with expertise in developing, adapting, and implementing evidence-based behavioral interventions for substance use disorders affecting children in the acute healthcare setting. Through the proposed K01 work, she plans to focus on child SHSe in the PED to acquire new skills needed to incorporate health promotion and disease prevention into the acute healthcare setting.